竖脊肌旁入路经椎间孔行椎管减压的应用解剖学研究  

APPLIED ANATOMICAL STUDY ON APPROACH NEXT TO ERECTOR SPINAE FOR SPINAL CANAL DECOMPRESSION THROUGH INTERVERTEBRAL FORAMEN

作　　者：徐希彦[1] 晏铮剑[1] 黄帆[1] 邱北溟[1] 邓忠良[1] 

机构地区：[1]重庆医科大学附属第二医院骨科,重庆400010

出　　处：《中国修复重建外科杂志》2013年第4期409-413,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过局部解剖方法,对脊柱胸腰段的竖脊肌旁入路经椎间孔到达椎管路径及其毗邻重要解剖结构进行观测,明确该入路的定位方法及安全范围,为竖脊肌旁入路经椎间孔行椎管减压提供解剖学基础。方法选取甲醛固定的成人尸体标本12具作为研究对象,其中男6具,女6具;年龄27～52岁,平均43岁;甲醛固定前身高154～177 cm,平均166 cm。观测T1～S1范围内部分节段水平的竖脊肌入路旁开距离、入路长径、入路与水平面的角度、椎间孔大小和节段动脉至椎体上缘的距离等指标。结果竖脊肌入路旁开距离在(41.75±3.29)mm至(74.54±7.08)mm范围内,入路长径在(66.75±10.81)mm至(97.13±13.35)mm范围内,入路与水平面的角度在(38.38±6.16)°至(53.67±4.40)°范围内,节段动脉至椎体上缘的垂直距离在(9.50±0.60)mm至(18.30±1.56)mm范围内。该入路在胸段以最长肌外缘作为起点,在腰段以髂肋肌外缘作为起点,能够顺利经椎间孔到达椎管内。同时,结合测量的各个椎间孔大小,该入路存在足够的安全空间进行椎管减压操作。结论竖脊肌旁入路通过肌肉间隙进入,经椎间孔到达椎管,从而达到减压的手术目的。该路径安全、可行,是一种微创手术入路。Objective To observe and measure the approach next to the erector spinae in the thoracic and lumbar segments of the spine and adjacent anatomical structures by the topographic method, to clarify the positioning method and safe range so as to provide the anatomical basis of the approach for spinal canal decompression. Methods Twelve formaldehyde- treated adult cadaver specimens were selected, including 6 males and 6 females with an average age of 43 years （range, 27- 52 years） and with an average height of 166 cm （range, 154-177 cm）. The related data of the approach at T1-S1 levels were respectively measured： the distance between the lateral edge of the erector spinae and the spinous process, the length of the approach, the angle between the approach and the horizontal plane, the size of intervertebral foramen, and the vertical distance between the segmental artery and the upper edge of the vertebrae. Results The distance between the lateral edge of the erector spinae and the spinous process ranged from （41.75 ± 3.29） mm to （74.54 ± 7.08） mm. The length of the approach ranged from （66.75 ± 10.81） mm to （97.13 ± 13.35） mm. The angle between the approach and the horizontal plane ranged from （38.38 ± 6.16） to （53.67 ± 4.40）~. The vertical distance between the segmental artery and the upper edge of the vertebrae ranged from （9.50±0.60） mm to （18.30 ± 1.56） ram. The size of foraminal was also measured. The spinal canal could reach when iliocostalis lateral edge was used as the starting point in the lumbar segments, and longissimus lateral edge as the starting point in the thoracic segments. It was confirmed that there was enough safe space for the spinal decompression without the resection of the articular process. Conclusion The approach next to the erector spinae can reach spinal canal to achieve the purpose of decompression through the intervertebral foramen. The minimally invasive approach is feasible and safe. It has the value of the operative application.

关 键 词：脊柱 竖脊肌 椎管减压 应用解剖 

分 类 号：R687.3[医药卫生—骨科学]